This revised application is in response to the NIMH Program Announcement for Exploratory Developmental Grants for Psychosocial Treatment Research. The program's goal is to stimulate the development and preliminary testing of standardized psychosocial treatments for mental health problems of public health significance for eventual testing in clinical trials. Coronary heart disease (CHD) is one of the most prevalent chronic illnesses in the United States. Major depression affects approximately one of every five patients with CHD, and it substantially increases the risks of cardiac morbidity, mortality, disability, and psychosocial maladjustment in this population. Unfortunately, antidepressants are often contraindicated for CHD patients, and there has been no systematic research on psychotherapy for depression in CHD. Consequently, most depressed CHD patients receive no treatment for depression. There is an urgent need for a safe and effective psychotherapeutic alternative to antidepressant medications for depressed cardiac patients. The aims are (1) to systematize a cognitive-behavioral intervention for depression and associated psychosocial problems in patients with CHD that has been under development since 1985 at Washington University School of Medicine; (2) to test and refine the intervention in a series of systematic case studies; (3) to produce a treatment manual, training procedures, and measures of therapist competence and adherence for use in future clinical trials; and (4) to train a team of six cognitive- behavioral psychotherapists who have not been involved in the other phases of the project to conduct a pilot efficacy study of the manualized intervention in a group of 30 depressed cardiac patients. The pilot study will yield preliminary data on the efficacy of the intervention, the magnitude of therapist effects, and the reliability of the adherence and competence measures. Feedback from patients, therapists, and supervisors will be used to further refine the treatment manual.